Healthcare Provider Details

I. General information

NPI: 1730384652
Provider Name (Legal Business Name): CASSANDRA K HARWICK LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25658 104TH AVE SE
KENT WA
98030-7610
US

IV. Provider business mailing address

26117 197TH AVE SE
COVINGTON WA
98042-5016
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-2828
  • Fax:
Mailing address:
  • Phone: 253-631-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00021049
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: